Psych/BD

Question 1

What are the 5 distinct stages of behavioral change?

Answer 1

1. pre-contemplation=denial of problem
2. contemplation=acceptance of problem and thinking about change
3. preparation=planning to make a change in near future
4. action=putting active changes into place
5. Maintenance=maintain change over a long time period

Question 2

Bulimia nervosa

Answer 2

• CP:
  
  • bilat parotid gland enlargement
  • erosion of dental enamel (from seld-induced vomiting; vomiting leads to electrolyte abnormalities and calluses on dorsum of hand=Russell’s sign
  • nml to overweight
• for classification need episodes for at least 1x/week for 3 months
• causes: hypotension, tachycardia, dry skin, menstraul irregularities
• Tx:
  
  • cognitive-behavioral therapy
  • nutritional rehab
  • selective serotonin reuptake inhibitors (SSRI)-FLUOXETINE

Question 3

Panic disorders

Answer 3

• recurrent, unexpected panic attacks
• young, healthy adult in ED with unexplained CP

Question 4

A. Clinical features of PTSD

B. Treatment

Answer 4

A.

• exposure to life-threatening trauma
• nightmares, flashbacks, intrusive memories
• avoidance of reminders, amnesia of event
• emotional detachement, negative mood, decreased interest in activties
• sleep disturbance, hypervigilance, irritability
• duration greater than or longer than a month

B.

• trauma-focused cognitive-behavioral therapy
• antidepressants (SSRIs, SNRIs)

Question 5

Body Dysmorphic D/O

Answer 5

• preoccupation wih a perceived defect in apperance and repetitive behaviors in response to pre-occupation
• CP: absent insight/delusional beliefs
• result: significant psychosocial dysfunction

Question 6

Schizophreniform D/O

Answer 6

• CP: psychotic symptoms:
  
  • delusions
  • hallucinations
  • disorganized speech/thought
  • disorganized behavior
  • negative symptoms (anhedonia, other a’s)
• last: >1mo, <6mo

Question 7

Social anxiety D/O

Answer 7

• excessive fears of scrutiny/embarassment in scial or performance situation
• result: significant distress and functional impairment

Question 8

Borderline Personality D/O

Answer 8

• persistent pattern of unstable relationships, mood lability, and impulsivity
• CP: suicidal ideation or behavior in the context of an interpersonal crisis in which they feel rejected/abandoned

Question 9

PCP

Answer 9

mong drugs of abuse, is most likely to induce violent behavior

Question 10

MDD DSM-5

Answer 10

• greater than or equal to 2 weeks with greater than or equal to 5 of the following s/s:
  
  • depressed mood, loss of interest, sleep disturbance, loss of energy, psychomotor agitation or retardation, impaired concentration, guilt, suicidal thoughts (SIGECAPS)

Question 11

Blinding Technique in Clinical trials

Answer 11

• can involve just pts or both pts and physicians (dbl blinding)
• main purpose: prevent pt or researcher from interfering with the determination of an outcoe (observer bias)

Question 12

MDD

Answer 12

Question 13

tx for GAD

Answer 13

• serotonin reuptake inhibitors and 5HT-NE reuptake inhibitors=first line
• benzo only for short term and for nondepressed pts with no hx of substance abuse who respond poorly to anti-depressants

Question 14

sleep deprivation-patient safety

Answer 14

• sleep deprivation in physicians often causes gonitive impairment resulting in medical errors
• physicians are responsible for self-regulating workloads to promote patient safety

Question 15

quality improvement-root cause analysis

Answer 15

• root cause analysis is a quality improvement measure that identifies what, how, and why a preventable adverse outcome occured
• first step: colect data mainly through interviewing mulitple individuals involved in the steps leading to the outcome

Question 16

What are three important anti-psychotic SE

Answer 16

• EPS (extra pyramidal SE)
  
  • acute dystonic rxn: sudden onset sustained muscle contractions
  • akathisia: subjective restlessness with inability to sit still
  • drug-induced parkinsonism: tremor, rigidity, bradykinesia, masked facies
• TD (tardive dyskinesia)
  
  • involuntary movements after chronic ise (lip smacking, choreoathetoid movements)
• NMS (neuroleptic malignant syndrome)
  
  • fever, rigidity, mental status changes, autonomic instability

Question 17

drug-seeking behavior

Answer 17

• be alert to red flags:
  
  • lost or stolen meds
  • pain inconsistent with PE
• attempt to clarify medication hx by using prescription monitoring programs or other information sources

Question 18

gifts from patients

Answer 18

• ethically problematic to accept expensive gifts as they may influence or appear to influence physician behavior
• gifts should be declined after expressing appreciation for the gesture